Provider Demographics
NPI:1952323388
Name:COPE, MARIE ELISA (PT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELISA
Last Name:COPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E MAIN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3337
Mailing Address - Country:US
Mailing Address - Phone:972-723-5005
Mailing Address - Fax:972-723-5008
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3337
Practice Address - Country:US
Practice Address - Phone:972-723-5005
Practice Address - Fax:972-723-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4774OtherBCBS TX
TX8T4774OtherBCBS TX